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Epidemiologists and Public Health Officials Becoming Embroiled In
Pandemic Control Conflicts
As
uncontrolled community transmission of COVID-19 persists in the United
States, epidemiologists and public health officials are involved in
difficult situations. Media accounts of firings, resignations,
harassment, and threats are proliferating. While there may be more
than one reason for these conflicts, failure to use evidence as the
primary basis for decision making is emerging as a common theme in
several situations. So is the highly polarized social and political
environment in the US.
Federal Level Preview
The
challenges that are playing out at the state and local level are a
reflection of similar challenges that have already produced headlines
about similar conflicts at the federal level involving all of the
major health agencies including the Centers for Disease Control and
Prevention, the Food and Drug Administration, and the National
Institutes of Health. Sometimes valid political and often serious
economic considerations are bumping up against scientific facts or
expertise.
List
of Turnovers
A list
maintained by Kaiser Health News (KHN) and the Associated Press
reportedly contains almost 50 state and local officials who have
resigned, retired, or been fired since April.
In an
article in The Hill, NIH Director Francis Collins stated “To
see this kind of really widespread resignations from critical roles at
a time of great importance for our country ought to be a source for
everyone to be concerned…I am very troubled to see that kind of
turnover…The idea that you have to either pick to support the economy
or pick public health measures is so upside down. The public health
measures are going to get our economy going again. And yet somehow in
many of these situations, these are pitted against each other in a way
that causes a great deal of anger and resentment and political furor
to kick in.”
In a
recent report, KHN quoted former CDC Director Tom Frieden “The
overall tone toward public health in the U.S. is so hostile that it
has kind of emboldened people to make these attacks.”
Bad
Feelings
In the
same report, KHN quoted former West Virginia public health
commissioner Dr. Cathy Slemp, who was forced to resign by
Republican Gov. Jim Justice in June. The past few months have been
“frustrating and tiring and disheartening” for public health
officials, said Slemp. “You care about community, and you’re committed
to the work you do and societal role that you’re given. You feel a
duty to serve, and yet it’s really hard in the current environment,”
Slemp added.
Examples
of these conflicts and challenges involving epidemiologists are
described below.
Indiana Episode
The
Indianapolis Star reports that
Eileen
White,
the only epidemiologist working for the local city Fishers Health
Department resigned earlier this month alleging too much interference
by the city’s mayor, especially pushing hard to open classrooms too
soon. In an account by the Indy Star, White says “This is a level of
interference I had never seen before in a public health agency…I have
never seen a health department set up as a business before… I have a
feeling of failure that all of us in public health have right now…I
had so much hope for what I could do. But we are continuing to see
more pushback and politics in public health.” White previously worked
for the Minnesota Health Department for three years. The mayor’s
office and White’s supervisor pushed back hard in a written statement
to the newspaper.
Official Response
"My
administration, in concert with the Fishers Health Department, has had
a constant focus on what is in the best interest and safety of our
residents," the statement read. "That said, we continue to believe in,
and follow the direction of, our public health department leadership,
(Chief Medical Director) Dr. Indy Lane and (Public Health
Director) Monica Heltz. Any assertion of anything other than
that is categorically false."
Heltz
said what White characterizes as interference she considers the full
backing of the mayor.
"I
have felt nothing but support from the city," she said. "The
suggestion that it has been anything but supportive is disappointing."
Hawaii Episode
In
Hawaii, the state epidemiologist Sarah Park has been sidelined
for not having in place the required number of contact tracers needed
to handle an upsurge of cases in the state. It apparently had a
plan for controlling the virus that was not adequately implemented,
according to the publication Civil Beat. Park reportedly had refused
to accept outside help offered months before the upsurge because she
believed the Department could bring on contact tracers quickly if
needed. Only about 100 contact tracers are actively working when
hundreds were called for three months previously. While continuing at
the Department to focus on other aspects of the pandemic, Park will no
longer oversee the contact tracing activities which have been
transferred to a Department deputy director and the chief of the
disease investigations branch.
Park
Testimony
In her
defense, Park gave testimony recently in front of a Senate Special
Committee on COVID-19. According to the Civil Beat article, “Park
downplayed the importance of contact tracing, saying that some states
no longer even do it. Park ultimately blamed the public for the surge
in cases. She cited beach and house parties and other gatherings that
people should have known not to engage in as causes for the surge in
cases that quickly overwhelmed the system. She was quoted saying “What
we could not have predicted, quite frankly, is how badly our community
would behave.”
South Carolina
Episode
In another situation
in South Carolina, state epidemiologist Linda Bell has
expressed regret in internal emails at not being more forceful and
speaking out in press briefings with the governor who has been
reluctant to require mandates for mask use and other measures.
According to the account published in The State, Bell said in emails
to agency public relations specialists that Gov. Henry McMaster’s
staff has been “somewhat manipulative” in meetings prior to news
conferences about the coronavirus. Bell also said her not speaking out
more from “a policy perspective is one of the reasons that South
Carolina is now among the states with the worst outlook.”
After these emails
became public, a
group of organizations
in the state issued an open letter of support for Bell.
In another
development, South Carolina lawmakers have called for top health
officials to speak out more frankly and forcefully about the pandemic.
Most people should be
disturbed by the emails, SC House Minority Leader Todd Rutherford
told The State.
He added, “We need to take steps to
separate the governor from DHEC (state’s Department of Health and
Environmental Control) and the governor from our chief epidemiologist
so that we can get data that is unvarnished by someone’s political
ideology.”
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